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Correlation between iatrogenic ulnar nerve injury and angular insertion of the medial pin in supracondylar humerus

Abdurrahman Ozçelik1, Aybars Tekcan, Hakan Omeroğlu

  • 1Department of Orthopaedics and Traumatology, Faculty of Medicine, Osmangazi University, Eskişehir, Turkey.

Journal of Pediatric Orthopedics. Part B
|November 11, 2005
PubMed

Insights

Anteroposterior insertion of medial pins during pediatric supracondylar humerus fracture fixation correlates with ulnar nerve injury. Surgeons should consider pin trajectory to minimize iatrogenic complications in type 3 fractures.

Area of Science:

  • Orthopedic Surgery
  • Pediatric Orthopedics
  • Pediatric Traumatology

Background:

  • Type 3 pediatric supracondylar humerus fractures are common and often treated with closed reduction and percutaneous fixation.
  • Iatrogenic ulnar nerve injury is a known complication of this procedure.
  • Pin insertion angles are suspected to influence nerve injury occurrence.

Purpose of the Study:

  • To evaluate the association between medial pin insertion angles (frontal and sagittal) and iatrogenic ulnar nerve injury.
  • To identify specific radiographic parameters that predict ulnar nerve complications in pediatric supracondylar humerus fractures.

Main Methods:

  • Retrospective review of radiographs from 90 children with type 3 supracondylar humerus fractures.
  • Measurement of frontal and sagittal humerus-pin angles (HPAs).
  • Comparison of mean sagittal HPAs between groups with and without ulnar nerve injury.

Main Results:

  • A significant difference was observed in the mean sagittal humerus-pin angle between the ulnar nerve injury group (12.1 degrees) and the no neurological complication group (1.6 degrees) (P=0.001).
  • Frontal humerus-pin angle did not show a significant correlation with nerve injury in this cohort.

Conclusions:

  • Anteroposterior insertion of the medial pin in the sagittal plane, particularly with the elbow in hyperflexion, is correlated with iatrogenic ulnar nerve injury.
  • Careful consideration of medial pin trajectory in the sagittal plane may help reduce the incidence of ulnar nerve injury during surgical fixation of these fractures.

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